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Streptokinase (Streprase) (Kabikinase)
Indication:
- deep vein thrombosis
- pulmonary embolism
- arterial thrombosis and embolism
- coronary thrombosis
- dissolving clots in arteriovenous cannula
Adverse reaction:
- anaphylactic response range from breathing difficulties to bronchospasm, periorbital swelling, or angioneurotic edema
- increased risk for bleeding
- hemorrhage infarction at site of myocardial damage
- reperfusion dysrhythmias
Nursing Implication
- assess for bleeding at puncture; apply pressure to control
- assess for allergic reaction and dysrhythmias during intracoronary cannulation and perfusion; assess pedal pulses for adequate circulation
- monitor client's thrombin time after therapy. do not administer herparin or oral anticoagulant until thrombin time is less than twice that of control
- do not shake vial when reconstituting; roll and tilt vial gently to mix
Tenecteplase (TNKase)
Reteplase (Retavase)
Indication: Acute management of coronary thrombosis
Adverse reaction: do not give if history of uncontrolled HTN - can cause hypotension
Nursing Implication:
- obtain baseline studies prior to administration: pt, ptt, cbc, fibrinogen level, renal studies, cardiac studies
- check for abnormal pulse, neurologic vital signs, and presence of skin lesions, which may indicate coagulation defects
- avoid needle punctures because of the possibility of bleeding; apply pressure of 10 minutes for venous punctures sites and for 30 minutes to arterial punctures sites; follow with pressure dressing
- be prepared to treat reperfusion dysrhythimas
Urokinase (Abbokinase)
Indication: pulmonary embolism, coronary embolism, IV catheter clearance
- is nonatigenic and does not cause allergic reaction otherwise has the same adverse reactions as those cited for streptokinase
- Infuse heparin and an oral anticoagulant following urokinase therapy to prevent rethrombosis
- is much more expensive than streptokinase therapy
- reconstitute immediately before use
Alteplase (Activase)
Anistreplase (Eminase)
Indication: deep vein thrombosis, pulmonary embolism, coronary thrombosis
Adverse reaction: interact with heparin, oral anticoagulants, and antiplatelet drugs to increase the risk for bleeding
Nursing intervention:
- alters coagulation only at the thrombus, not systemically (bleeding complications associated with streptokinase and urokinase are reduced with t-PA therapy)
- because t-PA is a human protein, allergic response is unlikely to occur
- half-life is 3-7 minutes; use immediately
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